Episode 1 Claimed and Shamed

TYRES SCREECH

Insurance fraud in the UK has hit epidemic levels.

It's costing us more than £1.3 billion every year.

That's almost £3.6 million every day.

Deliberate crashes, bogus personal

injuries, even phantom pets.

The fraudsters are risking more and

more to make a quick killing and,

every year, it's adding around £50

to your insurance bill.

But insurers are fighting back,

exposing just under 15 fake claims every hour.

Armed with covert surveillance systems...

That's the subject out the vehicle.

..sophisticated data analysis techniques...

TYRES SCREECH

Police!

..and a number of highly skilled police units...

Police! Don't move, stay where you are!

..they're catching the criminals red-handed.

Just don't lie to us.

All those conmen, scammers and cheats on the fiddle

are now caught in the act, and claimed and shamed.

A serial fraudster is brought down to Earth with a bump.

Mr Sudipo probably thought that rejecting this claim for the second

time is the worst thing that could happen to him.

However, there are severe penalties for fraud.

Secret filming proves to be the undoing of a man claiming to be so

badly injured he's unable to work.

There was absolutely no room to dispute that he was

working and was keeping that work hidden.

And, in the USA,

a convicted fraudster goes to extraordinary lengths to avoid

a ten-year prison sentence.

When we head off to work,

it's the responsibility of our employer to provide a safe working

environment. However, it's a fact of life that accidents will happen and,

in the event that disaster strikes,

insurance is there to protect both our employers and us.

But, of course, there are some people out there who see that as an

opportunity to cash in.

In 2015, there were over 600,000 workplace accidents...

..which resulted in over 30 million lost working days.

Allianz recently dealt with a case that first started over 15 years

ago, and highlights just how audacious some fraudsters are in

their pursuit of a pay-out, even if

they've already received compensation.

In 2001,

we received a genuine personal injury claim from a factory worker

called Mr Sudipo.

And, as injuries go,

this was far more than a sprained ankle or a few cuts and bruises.

He fell through a defective floor...

Ooh!

..which caused him to have a fractured vertebrae,

leading to a spinal cord injury.

Whilst on the face of it that appeared quite serious in nature,

the evidence indicated that this would be a situation where his

injuries would heal over time.

Thankfully, Mr Sudipo went on to make a full recovery.

But as the accident had occurred whilst he was at work,

he was entitled to compensation from his employer.

Based upon the evidence presented,

the claim was settled for the sum of £5,250.

So, that was that, then.

Well, not quite.

Usually, this would be the end of the matter.

To our surprise, nine years after this event...

..the same claimant pursued exactly

the same claim with the same

employer, under the same circumstances...

as we dealt with in 2001.

TABLET EFFERVESCES

This arose some suspicions internally

and started our investigation process.

Our claims handler immediately contacted the company who he

allegedly worked for at the time of the accident.

These checks soon validated that he was not employed, as alleged,

at the time of this accident.

In fact, he had not returned to work after the original accident in 2001.

So, let's get this straight.

Mr Sudipo had never returned to work at the company where he made

his first claim, so it was impossible for him to have had

another accident there. But, here he was, nine years later,

attempting to cash in with an identical claim.

No prizes for guessing what happened next.

Armed with this information,

it was an easy decision for Allianz to reject the claim.

For whatever reason,

Sudipo thought he could get the same claim through the system a second time.

But having discovered it wasn't as easy to get one over insurers as he

thought, you'd expect he'd call it a day.

Well, think again.

Unbelievably, to our surprise, this wasn't the end of the case.

The individual concerned then intimated a third claim related to

another workplace accident that allegedly took place in July 2012.

Again, this accident provided the same set of circumstances as

described in 2001 and 2008,

and alleged the same injuries.

MAN GASPS

Now, I'm no gambler, but even with my limited knowledge,

I'd say the odds of someone having exactly the same accident with the

same injuries three times in 12 years,

at a place he hasn't even worked at for 12 years,

are around absolute zero.

And, unsurprisingly, Allianz thought exactly the same.

Our checks carried out on the earlier claim clearly enabled us to

reject this claim immediately, without any further investigation.

If Sudipo thought he could chance his arm time after time

in the hope of a pay-out with no consequence, then he was sorely mistaken.

It was obvious at this point that the claimant didn't feel that there

was any consequences upon intimating the same claim three times.

Mr Sudipo probably thought that rejecting this claim for the second

time is the worst thing that could happen to him.

However, there are severe penalties for fraud,

and we have options to pursue various action against the individual concerned.

This action can lead to

prison sentence, fine,

community service or a criminal record.

And, armed with all the evidence available in this case,

the matter was referred by our claims handlers to IFED -

the Insurance Fraud Enforcement Department

for them to consider whether there

was options for criminal prosecution.

IFED were happy to take the case on, and brought Sudipo in for questioning.

IFED proceeded to take a statement from the claimant under caution,

as well as a statement from our claims handlers.

With this evidence, they made the decision to pursue the matter to court.

Ooh!

What had begun as a genuine and very serious accident worthy of

compensation had descended into an opportunist attempt to cash in again

and again, fuelled by greed.

But for Sudipo, it was the end of the line.

The claimant appeared at Magistrates' Court

where he entered a guilty plea.

The court handed down a 12-month community order,

80 hours of community service,

and the claimant was ordered to pay court fees and surcharges.

As you'd expect, fraud managers like Mark see more than their fair share

of chancers, but the sheer brazenness of Sudipo to claim for

the same accident not twice,

but three times, was a rare occurrence indeed.

The judgment handed down

demonstrates there are consequences attached to bringing dishonest claims.

The individual concerned has got a criminal record,

and now has to deal with the consequence of that record for the rest of his life.

..a claimant is given a rude awakening when she attempts to

upgrade herself to a better night's sleep.

They told us that this mattress was

not one of their high-end mattresses.

And a football fan is caught offside as he struggles to get his

story straight.

Home insurance can be a real life-saver and provides peace of

mind that should anything happen to any of our valuables, no matter how

big or small, they're protected. But many fraudsters are shameless,

concocting evermore creative tales in an effort to make a quick buck

at the expense of insurance companies.

You never know when disaster might strike in the home...

..from a blazing house fire...

..to an unwanted visitor.

A home insurance policy is there to

cover the cost of replacing our

possessions, like for like.

But as RSA's head of counter-fraud John Beadle knows,

not all claims are straightforward.

He was asked to look into a case for a claimant who thought they could

catch the insurer napping.

This case was a household policy

which had an accidental damage clause in policy.

The lady said she was cleaning her windows with bleach when she

accidentally knocked the bowl on to her bed,

and it caused damage to her

mattress, the bedclothes and the bed frame.

Spills around the house are nothing new,

although what set this one apart from your average home insurance

claim was the quality of the mattress in question.

Well, she obviously valued a good night's sleep because she told us

that the mattress was a very expensive Vispring mattress,

and the total claim was valued at £4,000.

At £4,000, this wasn't your average mattress.

It seemed like a perfectly legitimate claim at the time,

and we began to make arrangements to settle the claim.

So, in no time at all,

the woman would be enjoying a good night's sleep on a brand-new replacement mattress.

Generally speaking, we try and pay claims as quickly as possible.

We're quite proud of our ability to quickly settle claims and reinstate

people into the position that they were before the accident or loss occurred.

But we are quite sophisticated now in the way that we screen claims.

And, of course, we do inspect damage in the normal course of settlement of the claim.

Unfortunately for the woman,

it was at this stage that her claim

for a new mattress turned into a bit of a nightmare.

On inspecting the mattress,

we soon established that it wasn't as straightforward as it seemed.

When our people visited the premises,

they found that the label on the mattress had been torn out,

and on what remained had been written, hand-written,

"A Vispring mattress."

We didn't believe that that was the case,

so we began to challenge the claim

in respect of the damaged goods.

Unless it was part of the company's marketing strategy to make every mattress unique,

you wouldn't expect a £4,000 luxury product to feature a label with the

name hand-written in pen.

Unsurprisingly, the insurance company dug a little deeper.

We went and saw the bed manufacturers,

and they told us that this mattress was not one of their high-end mattresses.

Given the state of the mattress and the label,

this news wasn't exactly the shock of the century.

It was obvious that attempts had been made to portray what was a

standard type of mattress, probably valued at about £800,

as a high-end Vispring mattress.

If the woman thought she could swindle her way to a top-of-the-line

mattress five times the value of her original one,

then she really was dreaming.

It was pretty crude.

Clearly, this lady was trying to claim for goods which she wasn't

entitled to, rather than just be reinstated with the goods that had been damaged.

The woman's attempt to better her bedding had backfired badly, and it

was time to put this claim to bed.

We voided the policy for fraud

and the claimant got no compensation

for their damaged goods.

And I want to make the point that

people who think that it's OK to

exaggerate a claim in this way

should realise that, actually, it's fraud

and you will be found out,

because insurance companies are not a soft touch.

And the consequences are either that we will prosecute you or,

as in this case,

your name will be entered on the Insurance Fraud Register, which will

cause you problems in obtaining insurance cover in the future.

When it comes to the fight against insurance fraud,

the industry is stepping up its game,

with insurers going to increasing lengths to catch out dishonest individuals.

Many fraudsters make the mistake of thinking it won't be them that gets caught.

But as this next case demonstrates,

that couldn't be further from the truth.

I-cog Claims Management is a company that specialises in identifying

fraudulent insurance claims through various techniques,

including secret filming...

..and desktop investigation.

They recently took on a case where an insurer had doubts about whether

one of their policy holder's claims was genuine.

The claim that was presented to insurers was for an individual who

had said that he had fractured his right hand and wrist.

And clearly, as a result of that, he wasn't able to work in any capacity.

For many of us, an injury such as this would be disastrous for our livelihood.

However, the claimant in this case had made

provisions for the unexpected.

Fortunately for him, he had an income

protection policy and, as a result,

duly submitted a claim that he was unable to work.

PEN SCRATCHES

By the time we had actually received the claim,

he'd already received £20,000 in

payment, with a maturing value

against the entire policy reaching 28,000.

Thanks to this income protection policy,

the claimant had the luxury of being

able to make a full recovery,

safe in the knowledge that he would

still have money coming in until he

was fit enough to return to work.

A very nice position to be in, indeed.

But there was a problem.

The claim had been referred to us because the insurer just happened to

notice that the mobile phone number for the claimant was actually the

same of a self-employed renovation

business that had just set up in the area.

The rules on income protection policies are clear.

They're there to protect the policy-holder

in the event they cannot work.

So, if the claimant was working and running a business,

then Tara and her team could potentially be dealing with a fraudulent claim.

I actually decided that an enquiry be made with the renovation

company to see if we could obtain a quote.

During that inquiry,

not only was the claimant far too busy with renovation work to provide

us with a quote, he was actually going on holiday

and advised that he was actively

returning to a busy schedule upon return.

The phone conversation suggested that business was booming.

But it still didn't prove whether the claimant was definitely the man on the other end of the phone.

To be sure of that, Tara needed to take the

investigation a step further.

So, at that stage, we had an intelligence package,

and confirmation, with an enquiry.

So, the natural stage for me was to authorise for surveillance to then commence.

Secret filming, to you and I.

If successful, the undercover operation would provide the

insurance company with the bulletproof evidence

they needed to prove that the claim was fraudulent.

For several days, the surveillance team waited...

..and waited...

..and waited.

But nothing happened.

Perhaps the claimant wasn't actually working, after all.

On the first few days of the operation,

there wasn't really any activity to report.

Now, one may think, "Oh, well, we must have been wrong."

But, because the intelligence package was so strong,

we were confident that our findings would pay off.

Sure enough, the very next day, the claimant emerged.

The big question, though, is where was he going?

He was followed to several trade merchants.

And there was nothing to suggest his alleged injuries were preventing him

from using his right hand.

Here, he's actually lifted a bag of cement from the store,

carrying it in the broken and fractured right hand and wrist,

without any issue at all.

And now he's actually loading it into the vehicle.

If the man had ever suffered the injuries he was claiming for,

it definitely didn't look like they were causing him any problems now,

and, crucially, they definitely weren't preventing him from working.

Here, the claimant can be clearly seen carrying out what I would call

manual work, again using the right hand without any issue whatsoever,

and carrying out which, to me, was clearly work for payment.

I think what's important to note with this one is, during

the surveillance, he was still receiving payments for being unable to work,

and essentially being temporarily disabled in the hand.

Well, that wasn't what we secured on film.

The surveillance footage was the indisputable proof that Tara and her

team needed to confirm the insurer's suspicions.

It's quite interesting. There's a saying, "The camera never lies."

That's one of the beauties of surveillance as a tactic within the

claims validation process, because what you see on camera here,

there was absolutely no room to dispute that he was working and was

keeping that work hidden from his insurer.

But ultimately we found him out.

The findings of the investigation and a copy of the footage were

handed over to the insurer.

The claim was struck out and the claimant was blacklisted.

What was important is that we had identified a fraudulent claim that

had been admitted. Justice had taken its course,

and this person will never, ever get insurance like this again.

Dishonest claims like this cost all of us,

but the industry is going to greater lengths to identify those who commit them.

I think it's fair to say that most insurers do whatever it takes to

protect their genuine customer base,

and that we all have a duty to identify fraud,

secure the evidence and take the appropriate action.

Now, we've heard about the shocking lengths insurance cheats in the UK

will go to in order to cash in on an insurance policy.

But many of these crimes pale in comparison to how far some

fraudsters in the USA go to get their hands on money that they

simply aren't entitled to.

Property, or "real estate" as it's called on the other side of the pond, is big business.

One man who knew that all too well was Shannon Egeland.

He was the vice president of Desert Sun Development,

a real estate business that constructed commercial and

residential buildings in the state of Oregon.

However, Desert Sun Development

wasn't your average real estate company.

In fact, it was a front for a huge mortgage fraud operation

worth over 20 million.

Most of the funds the company secured for building properties

went straight into the pockets of Egeland and his accomplices,

with very little construction ever actually taking place.

As one of the principal orchestrators of the scam,

Egeland fraudulently obtained

millions of dollars, which he used

to fund a lavish lifestyle that included

multi-million dollar properties, luxury cars and boats.

Eventually, the scam was busted by

the FBI, and in January 2014,

Egeland was sentenced to ten years

behind bars for his part in the fraud.

After pleading with the court,

citing his wife's chronic health problems and the dire situation she

and their children would face,

the judge gave him six months to care for his ill wife

and ordered him to report to prison on the 1st of August 2014.

Now, having been given the luxury of another six months' grace as a free

man, you'd think Egeland would use this time wisely by looking after

his wife and spending quality time with his family,

but instead he used it to plot a way to delay his impending jail

sentence even further.

The day before Egeland was due to begin his ten-year jail term,

an incredible series of events unfolded.

He was driving near Caldwell, Idaho,

when he stopped to help a pregnant motorist.

But as he got out of the car, he was attacked.

GUNSHOT

By trying to be a Good Samaritan, Egeland had been viciously attacked,

and was now at risk of bleeding to death.

HE YELLS

Thankfully, the emergency services arrived in time

and Egeland was rushed to hospital.

As he needed extensive medical treatment,

Egeland's lawyer filed a request for his prison sentence to be

delayed by two and a half months.

However, when medical complications meant that Egeland's foot had to be

amputated, the sentence was postponed even further.

But the shooting just didn't add up.

The police couldn't find any motive for the attack, and nothing had been taken.

Egeland's phone, wallet and BMW were all left untouched at the scene.

As the police investigation continued,

the circumstances became increasingly suspicious.

It transpired that just a week before the shooting,

Egeland had fraudulently taken out a disability insurance policy.

In order to secure the policy, he had lied on the application form,

saying that he hadn't been arrested in the past ten years -

whereas he had, in fact, been arrested numerous times.

As part of the investigation,

Egeland's wife and teenage son were interviewed by the police,

and it was then that the extraordinary truth

finally came to light.

Under questioning,

Egeland's son broke down and confessed that his father had staged

the entire roadside encounter in an attempt to delay his prison sentence

and to cash in on his fraudulently obtained

disability insurance policy.

But most shocking of all was the identity of the attacker.

Egeland had maintained throughout it was a Mexican male,

but in actual fact, it was Egeland's own son.

Under his father's orders,

the teenage boy had shot him in the leg with a single barrel shotgun

that had been sourced by Egeland himself.

Unsurprisingly, news of Egeland's desperate attempt to escape jail

made headlines across the USA.

But ultimately, it made no difference to his fate.

Egeland was taken into custody to begin his ten-year prison sentence,

and was later charged with conspiracy to commit fraud.

As shocking as it is that a man would go to such lengths to avoid

jail whilst lining his own pocket at the same time,

what's truly unbelievable are the depths that he sank to by

implicating his own son in such a barbaric scheme.

Still to come...

A bus passenger has an appetite for compensation.

This lady has alleged some quite serious soft tissue injuries.

She didn't even know the impact had occurred.

Now, when it comes to validating

insurance claims, a simple rule of thumb is that if someone is genuine,

then they should be able to accurately recall their experience

and the facts surrounding it time and again.

So when insurers are faced with claimants who give inconsistent

accounts of what's happened, it can set alarm bells ringing -

and, in some cases, with good reason.

Travel insurance is one of those holiday

essentials that you hope you won't need to use,

but can save you a small fortune in the event that you do.

Simon Cook works at CEGA,

a Charles Taylor company that provides travel claim services.

His team recently dealt with a case

where a travelling football fan

appeared to have scored an own goal.

The customer told us that he had parked his vehicle up in Nice in

France, as he was due to watch some football matches.

And due to crowd troubles,

unfortunately, the car had been broken into

and he had his personal possessions stolen from inside the car.

The trouble between fans at the tournament had been well documented on the news.

We were fully aware that there had been crowd trouble associated with

the football matches in France, and it was reasonable that the

customer had driven his car to Nice, so, you know,

we had no real reason to believe that this was anything other than a genuine claim.

So far, so good...

..although the customer was missing a vital piece of documentation.

When dealing with crimes such as this,

we do really need a written police

report to substantiate the claim.

But on this occasion, the customer told us that due to the crowd

trouble, the police weren't able to assist him,

and therefore we decided that we would look into the claim without a police report.

The items being claimed for were a laptop and some clothing.

However, it wasn't long before CEGA began to suspect foul play.

We became suspicious with the claim because when we received the

customer's claim information pack,

he'd added an expensive camera and a watch to the claim,

having not mentioned either of these items to us during the initial call,

and even making reference to the fact that he didn't have any need to

make a claim for any other items.

We found it very hard to understand how the customer could recall such

small items of clothing like T-shirts and jumpers,

but he wasn't able to recall an expensive camera and a watch

as well when, bar the laptop,

these were the two most expensive items he was now claiming for.

Hold on a minute. He just said that the back window had been smashed,

but looking at the photo he submitted to back up his claim,

that's clearly one of the front windows.

And that wasn't the only thing that he'd got muddled up.

We also noted that there was an address spray-painted to a wall in the photograph,

so we decided to conduct some internet research on the address in question,

and to our astonishment,

the actual address was situated in Lille, and not Nice,

where the customer said the incident had occurred.

In case you're wondering,

the distance between Lille and Nice is just over 700 miles -

so, not exactly a minor mistake.

With such whopping inconsistencies,

one of Simon's investigators phoned the claimant to try and get some answers.

At the outset of the call, customer told us the incident had in

fact occurred in Lille and not Nice,

which was different to what he told us during the initial call.

He's not kidding. Thankfully, it's not every day most of us are victims

of crime, so when it does happen,

it's not something we're quick to forget the details of.

But the inconsistencies just kept on coming.

Whilst the phone call was going on, our investigator conducted some research

and realised that where he was going was a considerable distance away

from where he had parked his car.

As if there weren't enough question marks with this claim already,

our investigator then noted that the method of entry to the vehicle was

completely different in the photograph to what the customer had actually told us.

CLAIMANT: Erm...

So, to recap - since the original call to report the loss,

the location had changed from Nice to Lille.

The items taken had changed from a laptop and clothes to a laptop,

camera, watch and clothes.

The distance from the stadium had changed from a ten minute walk to

a seven and a half kilometre journey,

and the window that had been smashed had changed from the back of the car

to the driver's side.

As inconsistencies go, these were textbook examples.

We gave the customer the opportunity to provide us with reasonable

explanations for the issues that we had unearthed with the claim.

But unfortunately, he simply couldn't do that.

It took a while, but eventually,

the forgetful football fan said something that did make sense.

However, CEGA had heard enough and promptly reached for the red card.

If the claimant thought it was all over, it was now.

In my experience,

there is a misconception that low

value fraudulent claims will not be investigated,

but that is definitely not the case.

Now, transport companies up and

down the UK see all sorts of claims come in -

many of which are genuine, and many that are not.

But when it transpires that the event you're claiming for was so

minor you didn't even know it happened,

that really does take the biscuit.

With over eight billion journeys made on public transport

in the UK every year, the odd mishap is inevitable.

First Group operates a fleet of over 6,000 buses,

and when an incident happens on one of their vehicles,

it usually lands on the desk of Lee Ingram.

But as Lee knows all too well, not all claims are as they first appear.

We received a report following an incident where a bus had hit another

one in the rear, causing the windscreen to shatter.

TYRES SCREECH

CRASH

The claim had come in from one of the passengers in the rear bus,

saying that she had been injured as a result of this.

Later on when she attended the hospital,

she told them that she'd been thrown forwards and backwards,

resulting in some soft tissue injuries

severe enough to cause her to feel nauseous.

So, yeah, a not insubstantial degree of physical injuries.

With a smashed windscreen and no

question as to whether or not the collision had taken place,

Lee and his team began the process of settling the claim.

Early indications would suggest that there were no real reasons to be concerned about the claim.

We were satisfied an impact had occurred.

We tend to take these things on face value until we've examined all the evidence.

When it comes to evidence...

First Group are fortunate enough to have the best.

With multiple CCTV cameras and other hi-tech kit fitted to every bus,

Lee and his team often have the luxury of calling upon the ultimate eyewitness.

So as we watched the bus approach the stand, you're thinking, "Right,

"in a minute the bus driver's going to slam his brakes on, then he's

"going to hit the bus in front."

All right.

Here it comes. Any second now.

Now?

Hang on a minute!

What we actually see is a very gradual slow down,

and the mirror arm just pushes up against

the window of the bus in front,

causing it to break.

It's designed to do that when you apply pressure on it -

a fair amount of pressure, mind you.

But you can see that the driver's

just distraught, "What have I done, what's happened there?"

It's hardly the chassis-crushing carnage

this woman's account suggested.

Fortunately, First Group CCTV cameras have all the angles covered,

so perhaps the camera covering the claimant herself

would be more conclusive.

We then look at the lady in question just to see how much this alleged

jolt or impact could have affected her.

Was she thrown forward and backwards in her seat?

The answer to that question...

..is plain to see.

All she's really doing is eating,

and eating, and eating.

In fact, she didn't even know the impact had occurred.

HARP MUSIC

Blissfully unaware that anything's happened,

the CCTV wasn't exactly backing up the woman's claim.

This footage clearly shows that there were certainly no forces that

acted upon this claimant causing her to have sustained those injuries.

It appeared that in addition to baked goods,

this woman also had an appetite for compensation,

regardless of whether or not she was entitled to it.

It's disappointing to note that people still

will make claims like this.

I mean, in this instance, when you watch the incident unfurl,

it's some time after the actual impact she does look up,

and then she thinks, "Oh, something's happened."

She didn't know it had happened until she

actually looked up from her pie.

As far as Lee was concerned, a pay-out was definitely off the menu.

And the only pie the claimant would be eating after this was humble pie.

We repudiated the claim in full, and

we haven't heard back from them since.

Lee and his team had successfully

scuppered yet another spurious claim.

But no matter how many he deals with,

Lee knows full well this won't be the last.

When we look at footage of this nature and we see that someone's

clearly making up circumstances to fit a potential claim,

it sort of makes you disappointed in people's nature.

Why would they think that this is the right thing to do?

There are times when people will be injured,

and if there weren't so many of these people wasting our time,

we would be able to give our attention

more to those more deserving.

From organised criminal gangs to exaggerated household claims,

insurance fraud hits all of us in the pocket.

But instead of getting away with it,

more and more of these fraudsters are being claimed and shamed.